Weight-loss surgery increasingly
seen as
treatment for diabetes
By: Judy Foreman
February 18, 2008
Elizabeth Soto used to say no when
her husband suggested they go dancing. "I didn't
want to go," she said. "I felt tired and ugly." She
also was carrying 314 pounds on her 5-foot-7-inch
frame and had diabetes.
She had gastric bypass surgery
last June and now, at 235 pounds, the 38-year-old
Chelsea resident said she feels "energetic and
beautiful. I want to go out every weekend." Even
more astonishing, her blood sugar, which goes awry
in diabetes, normalized within days of her surgery.
A delighted Soto now proclaims: "My diabetes is
gone."
Doctors aren't quite ready to call
weight loss surgery a "cure" for Type 2 diabetes,
the most common form. "I would use the term
'remission,' because if people regain the weight,
the diabetes will come back," said Dr. Martin
Abrahamson, medical director of the Joslin Diabetes
Center.
But doctors sure have begun
encouraging their patients to get the surgery - for
diabetes and a host of other problems. More and more
doctors are recommending weight loss surgery to
their obese and diabetic patients, and they are
beginning to recommend it for less obese people,
said Dr. George Blackburn, director of the Center
for the Study of Nutrition Medicine at Beth Israel
Deaconess Medical Center.
"We've all been blown away by the
effectiveness of weight loss surgery," he said. "The
most severe type of obesity, leading to all these
horrible diseases - diabetes, heart attack, back
pain, cancer - can be treated by this surgery."
Nationally, the number of weight
loss operations soared 800 percent between 1998 and
2004, and another 11 percent between 2005 and 2006.
Americans get more than 205,000 weight loss
surgeries a year, according to the American Society
for Metabolic and Bariatric Surgery - a number which
is almost certain to keep climbing.
Research has shown that the
surgery is getting far safer as it is performed more
often. And more than 30 studies have found it
effective for treating diabetes.
In the most recent example, a
January study by Australian researchers, 60 obese,
diabetic patients were randomly chosen to have
laparoscopic adjustable gastric band surgery, a less
drastic procedure than what Soto had, or regular
treatment, which consisted of counseling on diet and
exercise, plus medications, if necessary.
The results were stunning.
Seventy-three percent of the surgical group were no
longer diabetic at the end of the two-year study
period, compared with 13 percent in the regular care
group. The banding surgery, in which doctors place a
balloon-like band around the stomach to make it
smaller, had been assumed to be "the least effective
operation for Type 2 diabetes, compared to the 'gold
standard,' gastric bypass," said Dr. Erik Dutson, an
assistant clinical professor of surgery at the UCLA
School of Medicine. But it turned that banding,
though it acts more slowly, also reverses diabetes.
Last summer, a Swedish study
showed that obese patients who had any of several
types of surgery were 29 percent less likely to be
dead a decade later than patients who had tried to
control their weight through diet, exercise, and
other methods.
And Utah researchers found a 40
percent reduction in deaths from all causes for
obese patients who had weight-loss surgery compared
with those who didn't, as well as a 92 percent
reduction in diabetes, 60 percent decline in cancer
deaths and 56 percent drop in heart disease deaths
for those who had had surgery.
To be sure, the surgery does not
cure all problems. Many people still experience
nausea, particularly if they eat sweets or greasy
foods after the bypass surgery called Roux-en-Y.
Risk for suicide also appears to
increase after weight-loss surgery, said Dr. Harvey
Sugerman, editor in chief of the journal Surgery for
Obesity and Related Diseases, perhaps because some
patients "attributed all their depression to
obesity. Then they have the operation, which takes
care of the obesity, but they are still depressed.
"They thought the surgery would
solve all their problems, but it didn't," he said.
Another factor in the rise of
stomach surgery is doctors' growing skill. The
national in-hospital death rate from weight loss
surgery declined from nine deaths for every 1,000
surgeries to two between 1998 and 2004, and has
declined even further since then, said Blackburn,
who also chairs a panel of 100 experts studying
weight loss surgery.
In Massachusetts, the death rate
dropped from an already-low average of 3 per 1,000
surgeries between 1998 and 2003 to a three-year
average (2004, 2005, 2006) of less than 1 death per
1,000 surgeries, Blackburn said.
And the biggest payoff of weight
loss surgery may be yet to come - avoiding surgery
altogether if scientists can understand a key
question: Why does diabetes get better literally
within hours after gastric bypass, even before
patients lose weight?
"That's a very good question -
every research center on the planet is working on
it," said Dutson of UCLA.
"There's a Nobel Prize for anyone
who can explain this," added Dr. Daniel Jones,
director of the bariatric surgery program at Beth
Israel Deaconess Medical Center.
Researchers already have some
clues. In Roux-en-Y surgery, part of the stomach is
tied off and the small pouch that is left is
connected directly to the small intestine, a
procedure that allows food to bypass the upper part
of the small intestine. The big plus is that when
you "change the plumbing," the production of insulin
is increased, thereby reversing diabetes, Blackburn
said.
Doctors suspect that bypass
surgery somehow increases levels of a protein called
GLP-1, which travels to the pancreas and tells
beta-cells there to make insulin. (A new diabetes
drug called Byetta seems to work in part through
this mechanism.)
As the success of weight loss
surgery grows, the number of patients clamoring for
surgery is expected to soar further. Since 1991,
federal guidelines have said that patients are
eligible for weight loss surgery if their body mass
index was 40 or more - someone who is 5-foot-6 and
weighs 250 pounds, for example - or if it was 35
coupled with another serious condition such as
diabetes, sleep apnea or heart disease.
But the recent Australian study
pushed the envelope, offering surgery to less heavy
patients. The US National Institutes of Health is
already forming a committee to revisit its
guidelines, Blackburn said.
For Linda Trainor, a nurse who
works with weight loss surgery patients at Beth
Israel Deaconess, watching obese and diabetic people
get better is immensely gratifying. What she enjoys
most, she said in an e-mail, "is their final freedom
from self degradation."
Robert Sisson, a 49-year-old
manufacturing engineer for
Raytheon
who lives in South Boston, can vouch for that. Until
November, Sisson tipped the scales at 376. Then he
had the banding procedure. Now, he weighs 306, and
his blood sugar levels are much better.
Hopping off his exercise bike
recently to talk, he said, "I should have had it
done years ago. My wife is going to get it done this
year."
Judy Foreman’s column runs every other week. Past
columns are available on
www.myhealthsense.com.
Listen to her live
call-in webcast radio show every Wednesday night
from 8:30 to 9:30 EST on
http://www.healthtalk.com.
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